Knowledge
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The association of anesthesia in the sitting beach-chair position with intra-operative stroke, continues to be controversial. Although some studies have identified this as a risk, it is still a rare complication, albeit devastating.
Expert opinion suggests intra-arterial blood pressure monitoring is best practice, but most importantly with consideration for actual cerebral perfusion pressure given the sitting position.
Some research suggests regional anaesthesia, possibly combined with spontaneous ventilation GA (rather than relaxation GA with IPPV) offers unique benefits that better maintain cerebral oxygenation, although the exact difference is unclear.
Similarly, the benefit and role of non-invasive cerebral perfusion monitoring has not been conclusively shown, although it appears logical that it may offer benefit in these patients.
Case studies of patients suffering cerebral ischaemia under beach-chair, do point to combinations of poor intra-operative blood pressure management and possibly pre-existing mild cardiovascular disease (eg. hypertension) as contributing to some degree.
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A collection of landmark papers relevant to anaesthesia and anesthesiology.
Generally, these papers are practice changing and hold current, ongoing significance beyond their historical importance.
This is a dynamic and changing document that will be updated, pruned and added to as appropriate. Many of these papers have free full-text provided by the publisher because of their significance.
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A collection of the top 20 most cited pediatric anesthesiology papers of all time from Ravi Tripathi's excellent 2011 study:
Tripathi, R. A bibliometric search of citation classics in anesthesiology. BMC Anesthesiol. 2011 Jan 1;11:24.
These are probably 20 articles that every anaesthetist or anesthesiologist with even a small component of pediatric practice should be aware of – not necessarily because they are still practice changing, but because they our foundational to our current understanding and practice of pediatric anesthesia.
These articles help to both show where we have come from, and where we may be heading.
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...and 2 more notes